“To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all”.
–Sir William Osler
This often quoted aphorism of Osler’s truly describes our emphasis on the primacy of the patient in the process of learning medicine. We passionately believe that learning of medicine is an active process at the bedside and, to that end, our residents find themselves in a supportive environment caring for an ethnically diverse population of patients and encountering as wide a spectrum of illness as can be encountered anywhere. We supplement these clinical experiences and “hands-on” learning with a didactic curriculum that covers important facets of internal medicine and that allows for in-depth discussion with our faculty. A comprehensive inpatient didactic curriculum is used at each of our inpatient training sites. Similarly, a comprehensive ambulatory medicine didactic curriculum occurs during ambulatory block rotations and in the weekly continuity clinic.
Inpatient Didactic Curriculum
Morning report takes place Monday through Saturday at all inpatient training sites is an interactive case-based discussion led by the chief residents with guidance and participation by faculty. One report each week is specifically for interns and Saturday report is for all housestaff in the hospital. We emphasize clinical reasoning and pathophysiology of disease in these discussions. Indications and accuracy of diagnostic testing, medical management and the literature supporting the most appropriate options are reviewed, and key concepts are summarized as “take home” learning points.
Medical Grand Rounds
Medical Grand Rounds takes place weekly at each Hospital. The Department of Medicine prides itself in the quality of its Medical Grand Rounds and the diversity and range of speakers. The following are broad categories of subjects generally selected:
- Dilemmas in diagnosis or management
- Interdisciplinary discussions of patients on the medical service
- Scientific advances and implications for patient care, current and future
- Clinical updates
- Medical Ethics
- Healthcare Policy and Healthcare access
- Global Health
- Medical errors and quality improvement
- A Writer’s Workshop
- Clinical Epidemiology
Summer Lecture Series for Interns
The summer lecture series is designed to address the initial evaluation and management of common inpatient issues and core skills interns need to develop on the medical service. Examples include: presentation and organization skills, effective and safe signout, and evaluation of patients with chest pain, endocrine emergencies, and acute shortness of breath.
Core Conference Series
A series of conferences occur two to three times weekly from September through June at each hospital. These conferences cover a wide range of common internal medicine topics using a variety of formats. The emphasis is on core clinical concept, evidence-based care, and clinical reasoning. Sample conferences include:
- Core topic seminars led by faculty (e.g., common conditions in all areas of medicine for example, atrial fibrillation, acute kidney injury, COPD exacerbations)
- Professor’s Rounds led by senior physician scientists and/or master clinicians
- Peer teaching conferences led by second and third year residents
- Journal Club led by third year residents
- Firm Conferences and Morbidy and Mortality Conferences led by the Firm Chiefs. These conferences are held twice monthly depending on the service and focus on a recent case from the inpatient teaching service. Firm Conference is centered on interesting and complicated cases, while Morbidity and Mortality Conference focuses on medical errors, near-misses, and systems-related issues in an attempt to identify these and prevent them from happening again. Both conferences enlist the active participation of the medical teams and specialists involved in the patients' care. A resident involved in the care of the patient is asked to prepare and present the case, under the supervision and guidance of the Firm Chiefs.
The ambulatory medicine didactic curriculum of the Yale Primary Care Residency is among the most comprehensive and effective seminar series offered in any training program. Details regarding the weekly Yale office-based medicine curriculum (now used by over 100 internal medicine residency programs nationally) and the ambulatory block core seminar series is described in the ambulatory medicine section of the website. These interactive seminars cover all major topics in outpatient general internal medicine with an emphasis on standard of care, clinical decision making, communication skills, physical examination skills, and psychosocial aspects of medicine.